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The newspaper article won this week's "no Duh" Award when it noted that "some econonimists are hesitant to increase the employers tax since they think SS taxes may be included in what the employer views as the total pay package." No shit, Sherlock. Only SOME economists think that??

Yeah. The are making ever so much more money at 1-2% in short term securities than they could actually buying something with it. \
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Kurt Ullman wrote:

Suppose you're Acme Appliances and you make, um, rice cake ovens. Your factory is running three shifts, totaling 600 workers, and, while you don't sell all you make domestically, you can export all you can produce. You've banked $10 million over the past two years in profits.
You're considering expanding your factory. It will cost $5 million. You'll triple your production and double your workforce.
But it's possible that the new health care law will end up costing you an additional $2,000 for each employee. That's $2.5 million per year - your working capital will be gone within two years after the new factory opens. In the current "Let's regulate the shit out of everything" governental mentality, you have completely unknown costs to accommodate these new, unknown, rules.
Taxes are going up at your local level as state revenue drops. Illinois, for example, just raised its corporate tax by 60%. How much extra will you have to pay next year?
No, the solution is to lie low, do nothing to put your company at risk, and weather the storm.
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Build the factory in China, keep the profits there, and let 'em eat rice cakes.

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snipped-for-privacy@att.bizzzzzzzzzzzz wrote:

Thought of that, but Acme would still have to pay tax on their foreign profits eventually.
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Not if they're never repatriated. That's *exactly* what's happening now.
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Since this is "let's assume", let's also assume that since all of the employees are covered by health care Acme has increased productivity due to less sick time and the need to train new employees. Just to be fair let us assume that each employee's new productivity amounts to $1.10 per hour which means that not only does Acme recoup the $2000 in health care costs, but gains an extra $200 per year, which would mean an extra $240,000 per year in additional profits.
But what would the fun be in that?
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On 7/26/2011 10:51 PM, Malcom "Mal" Reynolds wrote:

Except that the employees were _already_ covered w/ health care at less cost and higher benefits than are allowed under the new rules so that in fact they have less care available and higher costs than before.
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Except since they were covered with health care already, and that health care meets the minimums, which you acknowledge, they wouldn't incur any additional charges
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Malcom "Mal" Reynolds wrote:

(Giggle)
What about the bar down the street that doesn't cover his employees. Those employees will get coverage from tax money. And where will that tax money come from?
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From the fines imposed on those that don't meet the law
From the savings to the health care system because they catch/diagnose cirrhosis of the liver earlier thus preventing unnecessary liver transplants
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premiums, how is that supposed to work?

I ahve followed these things professionally for nearly 3 decades and the next study that shows this will be the first. Even in insured populations this doesn't show up.
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"Currently structured" answers your own question. If too many companies decide to pay the fine but not provide health care, the fines can be adjusted until they do. This law *should* have been passed when so many businesses *began* ditching health care and the problem hadn't become a nationwide epidemic.
Fixing healthcare is going to be a tough, ugly job because too many people make oodles of money with things just the way they are. MRSA is a perfectly example of the built in lack of incentives to actually *improve* healthcare. With 30 years experience, Kurt, surely you can tell us how hospitals made buckets of blood money making sick people even sicker from iatrogenic MRSA infections. At least until the Feds stepped in, that is. And even that will be a long, uphill battle.
By definition the free market cannot operate fairly in a system where you're buying a future service of unknown quality that can KILL you if poorly performed. What are your free market options when the market has killed you? To not buy THAT insurance again? A basic Federal minimum Medicare-like plan for everyone who's a citizen with the ability to buy all the Cadillac "gap" insurance for those who feel that the minimum is not good enough for them is where we are headed and will end up. It will just take a while.

But the concept is sound. The current structure of the health care system does very little to prevent ill health because that would rob them of expensive "Hail Mary" procedures downstream. Mal's point is still valid even if the example is not - and I don't even know if that's true. Just because something isn't studied doesn't make it false. It's just unstudied.
On the other hand, I can direct you to old journals full of studies showing ulcers were stress induced (they're not - they are bacterially caused). So even a study showing X is cause by Y has to be taken with a grain of salt - or some antibiotics. That's especially true when so darn many studies are funded by the drug makers themselves with the express intent to prove a product's efficacy or non-lethality. Common sense tells us that there are likely to be some conflicts of interest in those studies.
Looking for myself, it seems to be now "common wisdom" that early detection and treatment of cirrhosis can reduce the need for transplants:
http://www.google.com/search?q=cirrhosis+caught+early+reduces+need+for+liver+transplants
Makes sense to me, too, studied, unstudied, understudied or overstudied. Is your objection simply that no studies have confirmed this? Or are you actually saying that catching liver diseases earlier than where we tend to catch them now would have NO effect on the liver transplant rates?
-- Bobby G.
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people to the government plans. Interestingly enough, the same problem show in the MA plan, more or less the template for much of reform. And many people go in and out of insurance plans as needed since they can't be kept out due to pre-existing conditions. The REALLY scary part about MA is that, since inception of their reform, annual increases in premiums have gone from well below the national average to above it. Their general spending also has accelerated in a similar matter.

increase revenue.

The insurance isn't going to kill you though.
A basic Federal minimum

car makers (well MORE federalize carmakers) because a bad brake pad could kill me.

The concept is sound but there is no evidence of its usefulness so we should go ahead and do it anyway.

was sound (actually it still is but research has shown you need this other thing, too) until it wasn't.
That's especially true when so darn many studies are

impact on catching these things earlier. Even with insurance that covers annual physicals, the rates at which people take the time to actually do them is low. The magic behind preventive medicine is largely not supported by reality.

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And there's your answer: don't do the required annual physical and you get dinged financially
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On 7/29/2011 1:04 PM, Malcom "Mal" Reynolds wrote: ...

And there's the rub (but the apparent panacea to many) -- let the government control every aspect of every minute of everybody's life.
Thanks, but no thanks... :(
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Yes, of course. We'd be much better with volunteer armies, armor, armament. Also volunteer built bridges, tunnels, aquaducts etc would be better.
But then again with the current state of public education, who really cares
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On 7/29/2011 9:57 PM, Malcom "Mal" Reynolds wrote: ...

We do have if you hadn't noticed...
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Really? I'd sure like to see some of those homemade Abrams
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Well then all that's needed is either a homemade C-5A or Naval transport to bring it to the front.
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When one state alone does it, there are too many extra forces working against success. Just like legislators discovered that despite their draconian gun laws, DC was impossible to keep free of guns because it shared a border with Virginia, where getting guns in some counties is very, very easy. That's why the healthcare pool should include *everyone* since that's the only way to avoid the fervent desire of for-profit insurers to not insure sick or likely to be sick people. Who knows how many people came to MA looking for a freebie like so many immigrants flock to the US to have anchor babies? When you offer a benefit that nearby people don't have, they're going to move.
People will always pay more for their healthcare in a profit-based system than under a Medicare/Medigap system unless the latter is mis-managed to the hilt - and it may be. The government can use its enormous purchasing power to strike the kind of 40% Big Pharma discounts that only the Europeans get (on OUR medicine!!!!). They supply a basic formulary excluding experimental treatments. If you want that, you pay extra, just like if you feel you need flood insurance.
What's gumming up the works is the basic fact that commercial health insurers have no interest in *really* caring for the seriously ill. Payouts = lost profits. It's that simple. Anyone whose dealt with them knows that. That's why "pre-existing" crap started and the "recission game" came into being. Commercial insurers DO NOT WANT to insure sick or even likely to be sick people. Medicare evolved because some people over 55 couldn't buy health insurance at any price. People forget that it was the for-profit insurers refusomg to insure retirees that basically forced the birth of Medicare.
In a non-profit situation, there is no conflict between a patient's health and a for-profit corporation's need to pay huge salaries to the CEO and big dividends to the stockholders. Lots of people have to get their cut of my premium payment before I see a penny of benefits in the for profit system. I am still in awe of how many people believed that government health care meant "death panels." I was even more amazed to realize that so many people didn't know those "death panels" were already in full operation at for-profit insurers. People really seemed unaware that for profit insurers have teams that review the week's major claims and how to "stop-loss" them. For profit health insurance is a dirty, miserable business that does not operate in the interest of the customer's health (for which they are paid) but in the interests of their stockholders. That conflict alone is driving healthcare to unaffordable levels for a lot of people.

Those evil hospitals that refused to do the minimum required to keep a known killer infection at bay because they got MORE income for treating the patient for the disease THEY gave him. Tell me where the incentive IS for hospitals to keep the patient from acquiring MRSA? Nowhere. Giving a patient that came in for a routine surgery MRSA merely means guaranteeing a very expensive return visit. Is that evil? Is it criminal negligence? Is it stupidity? Or is it something that keeps the bucks flowing into a profit center and it won't be dislodged until it *doesn't* represent a lucrative ($50K per patient) followup business? They didn't invent it, but they sure have taken advantage of it and I think that makes them evil. YMMV.
<<For most countries badly affected by methicillin-resistant Staphylococcus aureus (MRSA) there have been many years of debate about its relative virulence compared with methicillin-susceptible S. aureus (MSSA) and whether it could be controlled. Now that it is endemic in the majority of hospitals around the world, it is clear that it is at least as virulent as MSSA and is an additional burden of healthcare-acquired infection. There is increasing evidence that, despite this endemicity, control efforts can be successful, although they are often perceived as expensive. In reality, there is a large body of consistent evidence that control is highly cost effective, particularly in the context of the huge societal costs of MRSA and the future ever-greater threats that it poses.>> Source: http://www.sciencedirect.com/science/article/pii/S0924857906003499
And yet it took the Federal threat to withhold payment for iatrogenic (medically caused) MRSA infections that the patient acquired previously at that hospital. A lot of people died A LOT of people. Twenty thousand a year according to some reports. Lots more people are horribly maimed by the "flesh eating bacteria" MRSA.
When a report says "cost effective" it should mean for the payers: the patient and insurers. Infecting people with a disease that guarantees a return visit brings is very cost effective for HOSPITALS because of the incredible extra revenue it represents. They're not about to cut off a revenue stream unless forced at financial gunpoint - and that's exactly what it took and the hospitals are finally responding. W i t h a l l d e l i b e r a t e s p e e d. I'll bet they're looking for loopholes as I write this.
How many people does MRSA kill?
http://www.medicinenet.com/mrsa_infection/article.htm says:
"Statistical data suggest that as many as 19,000 people per year die from MRSA in the U.S.; current data suggest this number has declined by about 25%-35% in recent years, in part, because of prevention practices at hospitals and home care."

You're a funny guy, Kurt. Bad insurance certainly CAN kill you if it denies you urgently needed medical care by stalling approvals for procedures and treatment long enough for you, the patient to die. Or are you going to really try to deny that those cases are not a dime-a-dozen to find? Do I *really* need to review the thousands (maybe tens or hundreds of thousands) of cases where people who died wrapped up in their medical insurer's red tape?
With your three decades in the business you HAVE to know all the tactics insurers use to keep premiums but avoid payouts. I'd hate to think you were "HeyBubbing" us. But you're dodging the question. How can the free market work when a bad choice in insurers can kill you? So in light of what I just wrote, perhaps you can explain why you believe "insurance isn't going to kill you" by denying you treatment that they deem "too expensive" or "not in our formulary." Unless, of course, you're playing silly word games with us as in "insurance doesn't kill people, diseases do." Freemarket rules don't work when it comes to a commodity that you may not need until 20 years after you've been paying for it.
Most people don't know they have bad health insurance until they get a denial in a life-threatening case. So where's the built-in competition and the freemarket buyer's ability to reject inferior goods? I have read over and over that people with advanced degrees in medical fields can't properly compare plan benefits because they are so complex. So I believe it's a given that people don't really know exactly what they are buying, or what it will really cover. It's a commercial gold mine and no wonder they are fighting Obamacare so hard. It might derail the gravy train for private insurers.

That's a bit non-sequitur, a bit specious and quite a leap of logic. We've come close to Federalizing carmakers - no, wait, we actually DID Federalize carmakers - literally. The point is that at least in safety areas like brakes the Feds specify what safety equipment is supposed to do and they do it with far more detail than what your health insurance will and won't pay for.
Brake pads have to be manufactured to stringent Federal specifications because your bad brakes may not only kill you, but may also kill many other people when you can't stop your car. So I ask again, if your health insurer stalls your treatment long enough to kill you how does the free market protect you when their self-interest (profits) collide with your self-interest (staying alive)? Remember, I will spank your ass rosy red if you keep denying such things happen with a dozen examples of people dying before their insurer decided if they'll pay. (-:
I read the LAT too often to have missed the antics of California's medical insurers, the absolute leaders in weaseling out of paying for their insured's medical care just with two nuclear options: recissions and pre-existing condition denials. A private insurer can renege on a payout for nearly any reason, and if you're too sick to fight and don't have family capable of fighting for you, you're likely to get stomped. To death. That's why Obamacare is here. Too many private insurers have figured out too many ways to rip off policyholders and refuse to pay what they promised. Other countries handle universal health just fine. We're beginning to look like the world's knuckleheads with all the unsolved problems we're facing.

Nonsense. The MRSA data alone indicates that when there's a clear benefit in prophylactic care, hospitals STILL refuse to get on board. It appears to take a much bigger hammer than clearly better patient outcomes to get them off their asses to do it right. And that's wrong. Or are you going to now claim there's no benefit to be gained by NOT infecting people with the flesh eating bacteria MRSA?

Say what? It proves MY point. Australians proved antibiotics cured the disease, but the best our US drug makers could come up with was expensive drugs that merely treated the symptoms. That's endemic of our current system. Don't cure - treat over a lifetime with expensive drugs.
If the fact that the medical establishment had proof up the wazoo that something was true when it wasn't makes your point then your point is perhaps pretty pointless. What is it you're trying to prove, anyway? That preventative care is meaningless? Doctors kept pushing useless treatments for ulcers that didn't cure the problem but were highly profitable to Big Pharma - who fought the Australian studies tooth and nail. That's MY point. Good health outcomes are secondary to the profits of the medical industries. When was the last time medicine cured something as serious as smallpox or polio? A long, long time ago.

Great. I'll take that as an admission that studies that show preventative care is useless were likely to be funded by drug companies who profit more from "treating for life" than they do curing or preventing..
> > Looking for myself, it seems to be now "common wisdom" that early detection

First of all, I don't believe Mal restricted himself to "insurance status" but regardless, when you're forced to admit that "reality" is determined by studies sponsored by drug companies that have a vested interest in selling more drugs, then it's clear that they would not be interested in proving that preventative care is worthwhile. Here's an interesting "study of past studies" by the NEJM (who assures us this report is bias free - although all the reports they're aggregating could be as biased as hell). It says that preventative measures can work:
<<Some preventive measures save money, while others do not, although they may still be worthwhile because they confer substantial health benefits relative to their cost. In contrast, some preventive measures are expensive given the health benefits they confer. In general, whether a particular preventive measure represents good value or poor value depends on factors such as the population targeted, with measures targeting higher-risk populations typically being the most efficient.>>
http://www.nejm.org/doi/full/10.1056/NEJMp0708558
The way these cost-benefit analyses are set up, there's a lot of fudge to factor in. I believe it was you who pointed out how subjective a concept like a QALY (quality adjusted life year) turns out to be.
When you factor in the newness of prevention as a tool in the medical toolkit, it's very likely we don't quite yet know *how* to best prevent disease. So I would expect prevention numbers to improve substantially as more feedback is acquired. Monitoring a hard drinker for signs of cirrhosis seems to be intuitive and perhaps as diagnostic imaging improves, we'll be able to catch liver failure and even more untreatable things like pancreatic cancer faster. AFAIK, pancreatic cancer is almost always fatal because it's so notoriously difficult to catch early and people only survive more than a few months if surgeons discover it, usually looking for something else.
New gene-based tests that can detect even a few pancreatic cancer cells are destined to come to market (although many have failed dismally) and eventually prevention studies like the NEJM's are going to show substantial shifts. It's really as common sense an idea as routine auto maintenance and inspection to detect small problems from becoming bigger. Only in the wacky world of medical statistics does that simple, time-proven idea get turned on its head.
-- Bobby G.
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